Criteria for physicians’ pay is too dynamic

Pay for performance. We all believe in it - base our pay raises on our ability and our performance. But, how is performance measured, and is the measurement itself accurate?

There are discussions about paying physicians based on performance, and it would seem appropriate. However, a recent study in the United Kingdom showed that this does not work. Paying for better outcomes not only did not result in better outcomes, but the cost of amassing the data was a negative cost factor. See the British Medical Journal, at www.bmj.com/content/342/bmj.d108.

Measurement of outcomes also assumes that the measurement criteria are accurate. Unfortunately, we learn all the time that what we “know” to be true today is false tomorrow. In my freshman year, in pharmacy school, we took a course - “History of Medicine and Pharmacy” - which taught us all the falsehoods, we “knew” to be true, historically.

Alas, that has not changed, as Dr. John P.A. Ioannidis, new chief of Stanford University's Prevention Research Center, provides extensive data to show that knowledge earlier in this decade has proved false later in the same decade: www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/? tool=pmcentrez

As with everyone, I want high-quality medical care. As with everyone else, I want all payments to be based on ability. Sometimes, the measurement criteria for accuracy are too rapidly changing to make what is “accurate” to be accurate.

Niles Ross

Cedar Rapids